How does post-traumatic glaucoma manifest, its treatment and consequences

Glaucoma received this name due to the discoloration of the pupil in the pathology of the eyes. In the period of the highest development of the pathological process, the pupil becomes a greenish or turquoise hue, so all the diseases with this change are called glaucoma( in Greek, "glaucoma" translates as turquoise, azure, and from German - green water).In fact, glaucoma is not a separate disease, but a whole group of similar pathological processes, with similar manifestations.

Among them, the most typical are:

1. Changes in intraocular pressure, which occurs periodically or is present on an ongoing basis, the process is of a chronic progressive nature;
2. Gradual processes of optic atrophy;
3. Disturbance of outflow of intraocular fluid;
4. Disturbances of visual functions according to a certain scheme;
5. Gradual development of the indentation in the region of the optic disc.

The most common glaucoma occurs in the older age group, but this does not mean that it can not occur at a young age or even infancy. Occasionally, cases of congenital disease are recorded. But still the main group is occupied by people older than 60 years.

Causes of post-traumatic glaucoma

There are many types of glaucoma, but one of the most dangerous forms of this disease is post-traumatic glaucoma, due to the fact that in most cases it leads to disability and complete blindness.

A very common cause of this type of glaucoma is any mechanical or chemical effect on the eye-injury, shock, chemical burn, resulting in changes in the anterior chamber of the eye and the neurovascular bundle of the eyeball. In connection with damage to the internal structures of the eye, the outflow of the intraocular fluid is disturbed, obstructions in the anterior chamber occur that prevent the intraocular moisture from circulating freely.

In addition, the cause may be the displacement of the lens of the eye or a change in its shape, which leads to blockage of outflow of fluid. As a result of the trauma, the lens may protrude into the anterior chamber, it swells and makes it difficult to move the moisture. Glaucoma caused by a lens injury is called phacogenic.

Sometimes post-traumatic glaucoma develops with the growth of connective tissue in the anterior chamber of the eye, which has grown in the course of the wound channel. With deep damage to the layers of the eye, healing is replaced by a rough scar tissue blocking the iris-corneal angle. And one more reason, which can lead to a similar pathology - metal foreign bodies, long staying in the eye. In them, oxidative processes occur, different metal compounds are released, they settle in the partitions of the anterior chamber of the eye and make it difficult to drain the fluid.

It should be clearly understood that it is the state of the angle of the anterior chamber that plays a major role in the circulation of moisture inside the eye, and the degree of opening of the angle influences the formation of increased intraocular pressure. The smaller the iris-corneal angle is open, the higher the intraocular pressure. Almost in 100% of cases, this mechanism leads to the development of glaucoma.

Types of post-traumatic glaucoma

At the moment there are many types of classification of the disease, but the type of violations are distinguished:

1. Contusional post-traumatic glaucoma;
2. Wounded;
3. Burning.

In any case, whatever the cause of the disease, there are the most typical symptoms:

1. The varying degrees of intensity of opacification in the cornea;
2. Atrophic processes in the iris and different degrees of pupillary deformation;
3. Full or partial displacement of the lens of the eye;
4. Reducing visual acuity, which occurs at different times from the onset of the disease;
5. Congestion and ulceration of the eyeball.

As complications, there may be associated diseases - aphakia, retinal detachment, bleeding in the eyeball.

Contusional post-traumatic glaucoma is inherent in blockade of the anterior chamber, it is blocked by the vitreous body or scar tissue( goniosinchia, moorings).Also, mechanical obstruction can occur with the lens of the eye, the remains of coagulated blood. In this case, outflow is difficult and intraocular pressure increases due to hernial protrusion of the vitreous and deformation of the anterior chamber angle.

In case of mechanical trauma or penetrating injury, hemorrhage to the anterior chamber of the eye( hyphema) or vitreous( hemophthalmus) can occur. However, the hyphema is formed in the first hours after the injury, and the hemophthalmia, as a rule, is formed gradually, after a considerable time( after a few days and even weeks) after the injury.

In the case of a lens dislocation during a trauma, secondary posttraumatic glaucoma develops several years after the injury, when the destroyed masses of the lens block the outflow of fluid from the eye.

After penetrating wounds of the eye, which may result in the flow of aqueous humor from the anterior chamber or lens injury, there are also changes in intraocular pressure. However, in the case of leakage of the intraocular fluid, the pressure drops sharply, but when the lens is damaged, its swelling and swelling are observed, which leads to a sharp increase in the pressure in the anterior chamber and the development of closed-angle glaucoma.

If the eye injury was not caused by a penetrating injury, but a significant number of foreign bodies got into the eyeball, glaucoma can develop as an acute glaucomatous attack, which requires immediate eye care. Otherwise, the victim may completely lose his sight.

For chemical burns, temporary glaucomatous conditions most often occur. Increased intraocular pressure is caused by damage to the vessels of the episclera( a layer of connective tissue between conjunctiva and sclera, very rich in blood vessels), resulting in the release of prostaglandins that increase intraocular pressure.

And one more feature of posttraumatic glaucoma - it has a reverse daily rhythm of fluctuations of intraocular pressure. The maximum pressure in the eye with this disease is observed in the evening and night, while the maximum pressure in the eye in the morning and afternoon is normal, and in the evenings and nights it is minimal.

Treatment of post-traumatic glaucoma

With increasing intraocular pressure, hypotensive therapy is mandatory, aimed at normalizing the pressure and circulation of moisture. In the early stages of post-traumatic glaucoma, timolol, diacarb and clonidine are recommended. In later terms, use miotic drugs - pilocarpine in the form of eye drops, fosfakol, tosmylen. Phosphacol can alternate with pilocarpine or acetylidine.

However, conservative therapy with post-traumatic glaucoma does not always have a positive effect and then there is a need for surgical correction of fluid outflow. The least traumatic operations include cryosurgery, laser iridectomy or trabeculoplasty.

In addition, vitrectomy or cyclocryocoagulation techniques can be used. The essence of vitrectomy is the removal of the vitreous humor, which facilitates the movement of the intraocular fluid. Vitrectomy is used for the retinal detachment of the eye, if the hemorrhage in the eye has not resolved itself. It is also shown in cases when there was a dislocation or subluxation of the lens to the vitreous, in this case not only vitrectomy, but also the removal of the lens.

Operations, with post-traumatic glaucoma, have developed a lot, but the ophthalmologist chooses the most acceptable method in each case separately. And for the prevention of the development of this disease, it is recommended that the wound be treated in the eye in a timely manner, and rational therapy should be applied to contusions, which should be aimed at reducing pain, swelling in the wound and eliminating hemorrhage.